Arizona Smokers’ Helpline

Tobacco Cessation with ASHLine:Blue Cross Blue Shield of Arizona

Mark Martz, PhD, MPAArizona Department of Health Services

Adrienne Lent, MBA, MPHASHLine

Blue Cross Blue Shield of Arizona Quitline Utilization

ASHLine Overview

ASHLine and Blue Cross Blue Shield of Arizona Partnership Opportunities

Agenda

Adult Cessation in Arizona: An Evolutionary History

Evolution of Adult Cessation in ArizonaASHLine was established in 1995 as one of the first US state quitlines

Nonprofit, academic-based at the University of Arizona*

Cessation services provided to all Arizonans

41% quit rate – second highest in the US 2016**

*Vendor selected through competitive RFP process (underway 2018)**North American Quitline Consortium FY 2016 Annual Survey

Evolution of Adult Cessation in ArizonaFuture tobacco cessation priorities aim to strategically align resources with need

• Target populations are shifting: AHCCCS, uninsured, underinsured

o Medicaid beneficiaries smoke at rates double the privately insured*

• Tobacco tax revenue is decreasing

o Arizona’s smoking rate is at an all time low

• Provide a high quality service that is sustainable

o Establish public-private partnerships

*Ku L, Bruen BK, Steinmetz E, Bysshe T. Medicaid tobacco cessation: big gaps remain in efforts to get smokers to quit. Health Aff (Millwood). 2016;35: 62–70. pmid:26733702

Insurance Status of ASHLine Clients 201730% of ASHLine clients are privately insured

16%

33%20%

30%

1%

UninsuredMedicaidMedicarePrivateOther

BCBS AZ members make up one third of ASHLine’s privately insured clients

Quitline Public-Private PartnershipsA win-win situation for all

Helps meet ACA criteria

Meets a critical need of healthcare

providers

High quality and effective

Cost effective

High satisfaction

among participants

Partnering is easy

BCBS North Carolina - State Quitline Partnership Success StoryBCBS of North Carolina partnered with the state quitline in 2015

39.8% Quit Rate2.95 ROI

10351171 1085

2015 2016 2017

# of BCBS NC Members Using the State Quitline

ASHLine Overview

Agenda

The ASHLine Approach

Personalized Behavioral Coaching & Quit Medication Support• Assigned quit coach• Provision of NRT

State-Wide Media Campaigns and Promotion• ~$4 million annually

State-Wide Health Systems Change• >10,000 healthcare provider

referrals annually

Research and Evaluation• Data driven practices• Driving the evidence-base

2nd Highest U.S. Quit Rate*

41%

*North American Quitline Consortium FY 2016 Annual Survey

Arizonans Serving Arizonansfor over 20 years

Bilingual, diverse and educated counseling staff.

ASHLine Coaching Services: Effective and Evidence BasedServices include combined medication and behavioral counseling

Doubles the chances of quitting for good!

+CounselingTelephone-based

Text message and email supportPersonalized – assigned coachSpecial population protocols

English and Spanish

MedicationNicotine Replacement Therapy:

GumPatch

Lozenge

North American Quitline Consortium. Quitline Services: Current Practices and Evidence Base 2016

Multi-Modal EngagementText messaging allows for increased client engagement and evaluation

How Clients Heard about ASHLine

Media campaigns and healthcare providers drive Arizonans to ASHLine

ASHLine FY2016 Annual Report

ASHLine Promotion: Unique Approaches to Statewide Engagement

ASHLine Media CampaignsASHLine media includes TV, print, billboards, online ads and more

Tailored ASHLine Materials ASHLine’s tobacco cessation program includes assistance with promotion

Population specific educational materials*

-Informed by internal data analysis

Self-help materials delivered to every client

-Print and electronic

Available in English and Spanish

*e.g., pregnancy, mental or behavioral health, electronic cigarettes, etc.

Culturally and linguistically appropriate

Health Systems ChangeASHLine aims to ensure all Arizonans are screened for tobacco use, advised to quit, and referred to cessation services

>10,000 Healthcare Provider Referrals Annually

Technical assistance

Tailored, in-office provider trainings

Support for integrated referral systems

Blue Cross Blue Shield of Arizona Quitline Utilization

Agenda

BCBS AZ 2017 Referring Healthcare Providers and LocationsASHLine works with BCBS AZ contracted providers and locations across the state

BCBS AZ Member Mode of Entry

75%

8%

17%

Member Mode of Entry into ASHLine Services Media ReferralContact ASHLine on their own

Passive ReferralContact ASHLine after recommendation from a healthcare providerProactive ReferralFax or electronic referral to ASHLine from a healthcare provider

Media and healthcare providers drive members to ASHLine

ASHLine FY2016 Annual Report

2017 ASHLine Service Utilization by Blue Cross Blue Shield of Arizona MembersASHLine provides behavioral coaching and 4 weeks of NRT

Members Enrolled 1,015Avg # Coaching Calls 42-Week NRT Orders 1,063Quit Rate 40%# Members Quit 406Referral Locations & Providers 175

Return on InvestmentDid ASHLine add value to Blue Cross Blue Shield of Arizona in 2017? YES!

$2,564*

Per person annual medical expenses from smoking

1,015Members enrolled

40%Quit rate

*Rumberger JS, Hollenbeak CS, Kline D. Potential Costs and Benefits of Smoking Cesstation: An Overview of the Approach to State Specific Analysis.; 2010. Adjusted for 2017 inflation

Savings: $1,040,984Cost: $185,049(Coaching & Medication)

ROI = 4.63=($1,040,984-$185,049)/($185,049)

ASHLine invested $185,049* in clinical service delivery in 2017 alone

• Behavioral Counseling: $149,205

• Nicotine Replacement Therapy: $35,844

ASHLine’s Estimated Added Value to Blue Cross Blue Shield of Arizona

*Based on 2017 costs of behavioral counseling and medication support

An estimated $3 million dollars invested since 2000

Estimated $17 million dollars in cost savings to BCBS AZ since 2000

This does not include state funded provider outreach or media campaigns.

Blue Cross Blue Shield Member Client Feedback

“My coach was so thorough in following up. She understood my concerns and addressed them. She was very honest with me and it helped me so much.” – May 2017

Blue Cross Blue Shield Members value ASHLine!

“My coach Ashley has been wonderful and was very supportive.” – January 2016

“I am thankful you guys were there to help me.” – August 2016

“Great service. Right on the ball.” – December 2016

“I give this program 120%, my coach was amazing! I appreciate you guys so much.” – February 2017

“My coach was fantastic. She helped me get back on track.” – May 2017

“This is an awesome program and it is great that you have people that are there for you and help you through the phone.” – November 2016

ASHLine Client Satisfaction Surveys 2015-2017

ASHLine and Blue Cross Blue Shield of Arizona Partnership Opportunities

Agenda

Arizona’s Strategic Planning & GoalsASHLIne service eligibility will begin transitioning July 1

Ensure tobacco cessation services for all

Arizonans.

-Health plan partnerships are key!

Reduce AZ’s smoking rate to <10%

-Current rate is 14.7%*

ASHLine has partnership opportunity options to ensure

members continue to receive tobacco cessation services.

*2016 Behavioral Risk Factor Surveillance System

ASHLine BCBS AZ – ASHLine Partnership

*New, enhanced version coming early 2019

Partnering with ASHLine is easy

• Establish contract beginning July 2018 – June 2019

• ASHLine does the rest!

• Enjoy the additional benefits

• Statewide media and marketing

• Healthcare provider outreach

Questions

Mark Martz, PhD, MPAArizona Department of Health Services

Mark.Martz@azdhs.gov

Adrienne Lent, MBA, MPHASHLine

adriennelent@email.arizona.edu